Medicaid fraud is a deliberate withholding or hiding of information or giving false information to get Medicaid or FAMIS Plus benefits. Medicaid fraud also occurs when a provider bills Medicaid for services that were not delivered to a Medicaid recipient, or if a recipient shares his/her Medicaid number with another person to get medical care. Anyone convicted of Medicaid fraud in a criminal court must repay the Medicaid program for all losses (paid claims and managed care premiums) and cannot get Medicaid for one year after conviction. In addition, the sentence could include a fine of up to $25,000 and/or up to 20 years in prison. You may also have to repay the Medicaid program for any claims and managed care premiums paid during periods you were not eligible for Medicaid due to acts not considered criminal.
Beginning January 1, 2026, Acentra will reduce turnaround times to 10 days for pended cases and 72 hours for expedited cases, with incomplete expedited requests now resulting in rejection. Expedited reviews only apply when delays could seriously impact a member’s life, health, function, or create risk of severe pain or emergency. A new Member Portal will launch, allowing Medicaid recipients to view authorizations and submit appeal documents. Providers are encouraged to use the Atrezzo Portal for faster, easier documentation submission and case communication. For more details see the attached newsletter below.
Take advantage of Acentra Health's online resources!
Acentra Health's training materials are available in various file formats which may require specific tools to enable you to view them. The file types and links to the associated tools which you may need to download and install are listed below:
